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THE OPEN-AIR TREATMENT OF THE TUBERCULOUS INSANE.
1672
,"the
Polyclinic
were not under the necessity of going to other schools to hear other teachers because the best of all teachers from all sides came to the Polyclinic. The great need of the Polyclinic was a hospital and if necessary they - must start a new one, but he thought it was well to remember that King’s College Hospital was to be vacant very soon and he asked why it was not possible for the Polyclinic to take over King’s College Hospital. He suggested the idea for the consideration of some millionaire. On concluding his speech Mr. Cantlie received a well-merited and ,,prolonged round of applause. Every word of his remarks -,was clearly heard by all present and it will be recognised that this was no slight oratorical success when it is stated that covers were laid for over 160 guests.
MILK ADULTERATION
IN
LONDON.
ANY organised movement that is calculated to reduce ’the extent to which the milk-supply of London is adulterated -chiefly in the form of watering-will be welcomed and the suggested action of the London.County Council in this matter should have a good effect. The Public Health Committee has agreed to recommend the Council to pass the following
motion :That it is desirable that application should be made to Parliament for powers to enable the Council, as the authority dealing with the whole ,,-’County, to secure at its own expense the analysis of samples of milk arriving at railway stations in London and subsequently distributed in the county; and that there would be further advantage if some system -existed by which the Conneil, as the central authority, could insure that the Sale of Food and Drugs Acts should be administered on a sufficiently comprehensive scale in each sanitary district within the
’county. This movement, if the Council agrees to the recommendation and eventually gains the powers which it asks it to seek, would, we are sure, do much to check the practice of watering milk. It seems to us, however, that the Local Government Board might find ground for objection to this proposal. Certain it is that however admirable the system of control may be as regards the milk delivered at the railway station or sold at the shops, there is no effective way of preventing the addition of water to the milk on its way to the consumer. ___
THE
OPEN-AIR TREATMENT OF TUBERCULOUS INSANE.
THE
IN a leading article1 and annotation2 in THE LANCET in May last attention was drawn to the system of open-air ’treatment and especially to the "tent-life"" of tuberculous insane patients as carried cut in America. In the Archives de Neurologie for November Dr. E. Chardon, medical superintendent, and Dr. G. Raviart, assistant physician, of the asylum at Armentieres, have published an account or a - similar plan of treatment begun in May, 1902, at that asylum. The asylum consists of 15 pavilions separately built and standing well apart from one another on extensive ..grounds. Pavilion No. 4, a large one, standing at a distance from the others and on soil well suited for this treatment (dry gravel soil, elevated situation, and well sheltered from cold winds by trees), was selected and 47 tuberculous ,,patients were placed therein. 26 presented marked signs of cavity in the lungs, 20 were in the stage of incipient cavity formation, and one was in the early stage of the disease. The warming and ventilation were found to be satisfactory and efficient and an equable temperature could be maintained indoors. The patients sat or walked out of doors many hours daily. A special dietary rich in tatty constituents was .adopted. Small doses of cod-liver oil were given twice daily to each patient. Disinfectants in the form of a 2 per - cent. solution of lysol were used in all utensils for sputa and the same chemical substance was employed in the process 1
2
THE THE
LANCET, May 2nd, 1903, p. 1249. LANCET, May 23rd, 1903, p. 1459.
of
washing or scrubbing floors and ’walls. An antiseptic spray charged with lysol was regularly and daily diffused into the atmosphere of the sitting rooms. The cubic capacity of the sleeping rooms was such as to allow each patient not less than from 28 to 30 cubic metres of air space. Under the above conditions of life the patients lived in the pavilion for 14 months. The records collected and the results obtained during that time, brief though it was, were gratifying. Dr. Chardon and state that amelioration of health and in general physical condition were almost improvement visible. The patients were weighed regularly everywhere week or more often. Many of them began to gain every after a few weeks of residence. Those who weight steadily were dull and demented in aspect and mood gradually became brighter and improved in their habits. The improvement was not only physical but moral, add Dr. Chardon and Dr. Raviart, for many at the end of their sojourn had learnt habits of hygiene and decency from improving mental capacity primarily brought about by the physical hygiene of the new life. Some patients improved so far that they could be discharged home to the care of their relatives. A full report is promised by Dr. Chardon and Dr. Raviart, but the brief record of the work published shows that the system has as much to commend it as the American method of tent life for the tuberculous insane.
Dr.
Raviart
CATHETER DRAINAGE IN THE INTERSTITIAL NEPHRITIS AND PYELO-NEPHRITIS OF PROSTATIC DISEASE. IN the Boston Medical and Surgical Journal of Nov. 19th Dr. A. T. Cabot has published important and original observations on the effect of catheter drainage in the interstitial nephritis and pye!o-nephritis of prostatic obstruction. The interstitial nephritis seems to be the result of the pressure of the urine on the kidneys when the outflow is obstructed and the pyelo nephritis to be due to ascending infection from the bladder. A bladder habitually emptied by the catheter is liable to be infected sooner or later. Dr. Cabot assumes that a patient with enlarged prostate and dilated bladder has some degree of interstitial nephritis if the urine is abundant and of low specific gravity and that he has probably pyelonephritis if there are also high fever and pyuria. The latter supposition is strengthened if one or both kidneys are enlarged and tender. In such cases he has found that a great amelioration or disappearance of the symptoms takes place on draining the bladder by tying in a catheter; at the same time he gives large quantities of water so as to flush out the kidneys and urinary tract. In some cases when constant drainage was too soon changed for intermittent catheterism a return of the fever and inflammatory symptoms occurred ; on the other hand, cn persisting with the continuous drainage long enough it could be dispensed with in time. The good effects may be explained by gradual contraction of the dilated ureters restoring the valvular condition of their oritices and by recovery of tone of the distended bladder. The first effect of continuous drainage on the urine is a considerable increase in quantity. In ore case the daily quantity rose from six to 16 pints. Then the amount gradually falls while the specific gravity rises. In some cases the quantity and specific gravity returned to normal. In others, while stopping short of this, the urinary excretion reached a point which was adequate. Dr. Cabot does not propose this method of treatment as a substitute for operations but as applicable to old and broken-down
patients not fit for operation and as a means of preparing patients for operation. Patients with pyelo-nephritis and incipient uræmia may be so restored as to undergo without serious risk operations otherwise almost certainly fatal. In the introduction to catheter life of patients with t
,"the
Polyclinic
were not under the necessity of going to other schools to hear other teachers because the best of all teachers from all sides came to the Polyclinic. The great need of the Polyclinic was a hospital and if necessary they - must start a new one, but he thought it was well to remember that King’s College Hospital was to be vacant very soon and he asked why it was not possible for the Polyclinic to take over King’s College Hospital. He suggested the idea for the consideration of some millionaire. On concluding his speech Mr. Cantlie received a well-merited and ,,prolonged round of applause. Every word of his remarks -,was clearly heard by all present and it will be recognised that this was no slight oratorical success when it is stated that covers were laid for over 160 guests.
MILK ADULTERATION
IN
LONDON.
ANY organised movement that is calculated to reduce ’the extent to which the milk-supply of London is adulterated -chiefly in the form of watering-will be welcomed and the suggested action of the London.County Council in this matter should have a good effect. The Public Health Committee has agreed to recommend the Council to pass the following
motion :That it is desirable that application should be made to Parliament for powers to enable the Council, as the authority dealing with the whole ,,-’County, to secure at its own expense the analysis of samples of milk arriving at railway stations in London and subsequently distributed in the county; and that there would be further advantage if some system -existed by which the Conneil, as the central authority, could insure that the Sale of Food and Drugs Acts should be administered on a sufficiently comprehensive scale in each sanitary district within the
’county. This movement, if the Council agrees to the recommendation and eventually gains the powers which it asks it to seek, would, we are sure, do much to check the practice of watering milk. It seems to us, however, that the Local Government Board might find ground for objection to this proposal. Certain it is that however admirable the system of control may be as regards the milk delivered at the railway station or sold at the shops, there is no effective way of preventing the addition of water to the milk on its way to the consumer. ___
THE
OPEN-AIR TREATMENT OF TUBERCULOUS INSANE.
THE
IN a leading article1 and annotation2 in THE LANCET in May last attention was drawn to the system of open-air ’treatment and especially to the "tent-life"" of tuberculous insane patients as carried cut in America. In the Archives de Neurologie for November Dr. E. Chardon, medical superintendent, and Dr. G. Raviart, assistant physician, of the asylum at Armentieres, have published an account or a - similar plan of treatment begun in May, 1902, at that asylum. The asylum consists of 15 pavilions separately built and standing well apart from one another on extensive ..grounds. Pavilion No. 4, a large one, standing at a distance from the others and on soil well suited for this treatment (dry gravel soil, elevated situation, and well sheltered from cold winds by trees), was selected and 47 tuberculous ,,patients were placed therein. 26 presented marked signs of cavity in the lungs, 20 were in the stage of incipient cavity formation, and one was in the early stage of the disease. The warming and ventilation were found to be satisfactory and efficient and an equable temperature could be maintained indoors. The patients sat or walked out of doors many hours daily. A special dietary rich in tatty constituents was .adopted. Small doses of cod-liver oil were given twice daily to each patient. Disinfectants in the form of a 2 per - cent. solution of lysol were used in all utensils for sputa and the same chemical substance was employed in the process 1
2
THE THE
LANCET, May 2nd, 1903, p. 1249. LANCET, May 23rd, 1903, p. 1459.
of
washing or scrubbing floors and ’walls. An antiseptic spray charged with lysol was regularly and daily diffused into the atmosphere of the sitting rooms. The cubic capacity of the sleeping rooms was such as to allow each patient not less than from 28 to 30 cubic metres of air space. Under the above conditions of life the patients lived in the pavilion for 14 months. The records collected and the results obtained during that time, brief though it was, were gratifying. Dr. Chardon and state that amelioration of health and in general physical condition were almost improvement visible. The patients were weighed regularly everywhere week or more often. Many of them began to gain every after a few weeks of residence. Those who weight steadily were dull and demented in aspect and mood gradually became brighter and improved in their habits. The improvement was not only physical but moral, add Dr. Chardon and Dr. Raviart, for many at the end of their sojourn had learnt habits of hygiene and decency from improving mental capacity primarily brought about by the physical hygiene of the new life. Some patients improved so far that they could be discharged home to the care of their relatives. A full report is promised by Dr. Chardon and Dr. Raviart, but the brief record of the work published shows that the system has as much to commend it as the American method of tent life for the tuberculous insane.
Dr.
Raviart
CATHETER DRAINAGE IN THE INTERSTITIAL NEPHRITIS AND PYELO-NEPHRITIS OF PROSTATIC DISEASE. IN the Boston Medical and Surgical Journal of Nov. 19th Dr. A. T. Cabot has published important and original observations on the effect of catheter drainage in the interstitial nephritis and pye!o-nephritis of prostatic obstruction. The interstitial nephritis seems to be the result of the pressure of the urine on the kidneys when the outflow is obstructed and the pyelo nephritis to be due to ascending infection from the bladder. A bladder habitually emptied by the catheter is liable to be infected sooner or later. Dr. Cabot assumes that a patient with enlarged prostate and dilated bladder has some degree of interstitial nephritis if the urine is abundant and of low specific gravity and that he has probably pyelonephritis if there are also high fever and pyuria. The latter supposition is strengthened if one or both kidneys are enlarged and tender. In such cases he has found that a great amelioration or disappearance of the symptoms takes place on draining the bladder by tying in a catheter; at the same time he gives large quantities of water so as to flush out the kidneys and urinary tract. In some cases when constant drainage was too soon changed for intermittent catheterism a return of the fever and inflammatory symptoms occurred ; on the other hand, cn persisting with the continuous drainage long enough it could be dispensed with in time. The good effects may be explained by gradual contraction of the dilated ureters restoring the valvular condition of their oritices and by recovery of tone of the distended bladder. The first effect of continuous drainage on the urine is a considerable increase in quantity. In ore case the daily quantity rose from six to 16 pints. Then the amount gradually falls while the specific gravity rises. In some cases the quantity and specific gravity returned to normal. In others, while stopping short of this, the urinary excretion reached a point which was adequate. Dr. Cabot does not propose this method of treatment as a substitute for operations but as applicable to old and broken-down
patients not fit for operation and as a means of preparing patients for operation. Patients with pyelo-nephritis and incipient uræmia may be so restored as to undergo without serious risk operations otherwise almost certainly fatal. In the introduction to catheter life of patients with t